Poster Abstract Title: Pharmacist-Led Calcium Replacement in Trauma Patients
Primary Author: Aileen Jimenez
Contact:
[email protected]Co Authors: Heather Wilson and Madeline Mitchell
Background: Blood product administration has been associated with hypocalcemia in trauma patients receiving massive transfusion protocol (MTP) due to the binding of calcium by citrate. Calcium plays an important role in cardiac contractility and associated cardiac output. It also serves as a cofactor for vitamin K dependent clotting factors in the coagulation cascade; therefore, hypocalcemia is associated with increased mortality in trauma patients given its ability to potentiate coagulopathy, acidosis, and hypothermia. The purpose of this project was to evaluate the impact of standardized, pharmacist-led calcium replacement on hypocalcemia within 36 hours of administration of blood.
Methods: This is an IRB-reviewed, determined exempt, retrospective chart review from July 1, 2024
to February 28, 2026. Adult trauma patients, 18 years or older, who received two or more units of blood within a 24-hour period, and were subsequently admitted to an ICU were included. Data points include volume of blood products received, type and dose of calcium product received, timing of first basic metabolic panel (BMP) or arterial blood gas (ABG) after receipt of blood products, ionized calcium, serum calcium, and/or corrected calcium, and occurrence of hypo-/hypercalcemia. The primary outcome of this study was incidence of hypocalcemia within 36 hours the blood transfusion event. Secondary outcomes included achievement of normocalcemia within 36 hours of the blood transfusion event, continued normocalcemia at 72 hours, time between pRBC administration and calcium replacement, time between pRBC administration and first normalized calcium, percentage of patients with hypocalcemia who received calcium within 36h, and in-hospital mortality.
Results: Overall, 47 patients were included: 30 patients in the pre-group and 17 in the post-group. Baseline characteristics were similar between groups except for volume of fresh frozen plasma (FFP) and cryoprecipitate received (p<0.05). There was a statistically significant difference in the primary outcome of hypocalcemia within 36 hours in the pre-group vs post-group, respectively (90.0% vs 58.8%; Fisher's Exact OR: 0.1587; 95% CI (Corrected): [0.0416, 0.7630];
p=0.0232].. Additionally, there was a statistically significant difference
in achievement of normocalcemia within 36 hours (55.6% vs 20.0% ; [OR: 0.2000 95% CI (Corrected): [0.0481, 1.1689]
p<0.05) and time between pRBC administration and calcium replacement (9.6 hours v 5.8 hours; [median difference -3.79; 95% CI: [-10.71, -1.23];
p<0.05]). Overall, calcium was replaced more frequently in the pre-group compared to the post-group, but this difference was not statistically significant (56.7% vs 47.1% [OR 0.6797; 95% CI [0.2150, 2.2158];
p=0.5583).
Conclusion: The results suggest that the implementation of a pharmacist-led calcium replacement protocol resulted in less hypocalcemia at 36 hours; however, these results may be influenced by calcium being normal at baseline in the post-group. While pharmacist-led calcium replacement was also associated with a significantly lower time to calcium replacement, this did not result in quicker resolution of hypocalcemia. Limitations of this research include a small sample size, retrospective nature, potential for calcium receipt prior to ICU admission, and lack of differentiation between whole blood and pRBC. Future studies assessing a larger group would be beneficial to more clearly delineate the role of pharmacist-led calcium replacement on calcium levels in trauma patients.
